Report a Confined Space Incident

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Person Reporting Incident Report Incident Anonymously

           Male Female

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Person Involved in Incident Same as person reporting incident.

    Male Female

Expanded Details on Person Involved
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Farm work-related Commercial grain storage and handling facility Recreational/child playing
Other (specify)

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Farm operator Family member Outside contractor Visitor Other Unknown

Full-time Part-time NA Unknown
Location of Incident

Incident Details   

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Morning Afternoon Evening Unknown


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Loading Unloading Other Unknown

Newspaper clipping
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